Gastric-type adenocarcinoma of the cervix in patients with Peutz-Jeghers syndrome: a systematic review of the literature with proposed screening guidelines

2021 ◽  
pp. ijgc-2021-002997
Author(s):  
Sushmita B Gordhandas ◽  
Ryan Kahn ◽  
Dib Sassine ◽  
Emeline M Aviki ◽  
Becky Baltich Nelson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Pap Smear ◽  
Early Stage ◽  
Case Reports ◽  
High Risk Population ◽  
Normal Cytology ◽  
Presenting Symptoms ◽  
Gastric Type ◽  
Peutz Jeghers Syndrome

ObjectivesTo perform a systematic review of gastric-type adenocarcinoma of the cervix and lobular endocervical glandular hyperplasia (a possible precursor lesion) in Peutz-Jeghers syndrome, and to analyze data from the literature, along with our institutional experience, to determine recommendations for screening and detection.MethodsA comprehensive literature searc and retrospective search of pathology records at our institutio were conducted. Articles were screened by two independent reviewers. Case reports/series on lobular endocervical glandular hyperplasia/gastric-type adenocarcinoma of the cervix in Peutz-Jeghers syndrome were included. Demographic, clinical, and radiologic information was collected.ResultsA total of 1564 publications were reviewed; 38 met the inclusion criteria. Forty-nine were included in the analysis (43 from the literature, 6 from our institution). Forty-three reported on gastric-type adenocarcinoma alone, 4 on lobular endocervical glandular hyperplasia alone, and 2 on concurrent lobular endocervical glandular hyperplasia/gastric-type adenocarcinoma. Median age at diagnosis was 17 (range, 4–52) for patients with lobular endocervical glandular hyperplasia alone and 35 (range, 15–72) for those with gastric-type adenocarcinoma. The most common presenting symptoms were abdominal/pelvic pain and vaginal bleeding/discharge. Imaging was reported for 27 patients; 24 (89%) had abnormal cervical features. Papanicolaou (Pap) smear prior to diagnosis was reported for 12 patients; 6 (50%) had normal cytology, 4 (33%) atypical glandular cells, and 2 (17%) atypical cells not otherwise specified. Patients with gastric-type adenocarcinoma (n=45) were treated with surgery alone (n=16), surgery/chemotherapy/radiation (n=11), surgery/chemotherapy (n=9), surgery/radiation (n=5), or radiation/chemotherapy (n=4). Twelve (27%) of 45 patients recurred; median progression-free survival was 10 months (range, 1–148). Twenty patients (44%) died; median overall survival was 26 months (range, 2–156). Thirteen patients (27%) were alive with no evidence of disease.ConclusionsGastric-type adenocarcinoma in Peutz-Jeghers syndrome is associated with poor outcomes and short progression-free and overall survival. Screening recommendations, including pathognomonic symptom review and physical examination, with a low threshold for imaging and biopsy, may detect precursor lesions and early-stage gastric-type adenocarcinoma, leading to better outcomes in this high-risk population.PROSPERO registration numberCRD42019118151

Signs and symptoms associated with synthetic cannabinoid toxicity: systematic review

2016 ◽  
Vol 24 (6) ◽  
pp. 598-601 ◽  
Author(s):  
Julie Courts ◽  
Virginia Maskill ◽  
Andrew Gray ◽  
Paul Glue
Keyword(s):  
Systematic Review ◽  
Emergency Services ◽  
Case Reports ◽  
Synthetic Cannabinoids ◽  
Case Series ◽  
Signs And Symptoms ◽  
Synthetic Cannabinoid ◽  
Symptom Reporting ◽  
Presenting Symptoms ◽  
Study Population

Aims: Use of synthetic cannabinoids is associated with significant physical and psychological harms. This research quantified reported toxicities from published reports and assessed the influence of size of the reported study population on rates of symptom reporting. Methods: Systematic review of published case reports and case series of toxicity associated with use of synthetic cannabinoids. Results: Symptoms associated with synthetic cannabinoid toxicity were reported for 3695 individuals, predominantly young males. Symptoms included physiological (e.g. tachycardia, hypertension, nausea/vomiting), emotional (e.g. agitation, irritability, paranoia), behavioural (e.g. drowsiness, aggression) and perceptual (e.g. hallucinations) domains. Most common symptoms were tachycardia (30.2% of cases), agitation (13.5%), drowsiness (12.3%), nausea/vomiting (8.2%) and hallucinations (7.6%). Death or serious medical complications were uncommon (e.g. death 0.2%, stroke 0.1%, myocardial infarction 0.09%). Case reports/smaller case series ( n<10) reported statistically significantly higher rates for 29/34 symptoms than larger case series ( n≥10), which could represent selection bias. Conclusions: Symptoms of synthetic cannabinoid toxicity are variable and cover a number of physical and psychological domains. Symptom reporting varies by study population size. Due to the variable presenting symptoms of synthetic cannabinoid toxicity, clinicians in emergency services should consider synthetic cannabinoid toxicity when evaluating young adult male patients presenting with unexplained agitation or cardiovascular symptoms.

scholarly journals Myocarditis associated with Covid-19 disease: a systematic review of published Case reports and Case series

2021 ◽  
Author(s):  
Sawai Singh Rathore ◽  
Gianpier Alonzo Rojas ◽  
Manush Sondhi ◽  
Suveenkrishna Pothuru ◽  
Reshma Pydi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Acute Myocarditis ◽  
Case Series ◽  
Cardiac Biomarkers ◽  
Pulmonary Tissue ◽  
Mortality And Morbidity ◽  
Presenting Symptoms ◽  
St Segment ◽  
Inflammatory Infiltrates

Background: Covid-19 is an extremely contagious illness caused by the severe acute respiratory syndrome (SARS-CoV-2) virus. Although this disease primarily involves pulmonary tissue, rapidly advancing research has established cardiac involvement in Covid-19 patients. Objective: This systematic review article aimed to compile and illustrate clinical characteristics, diagnostic findings, management, and outcomes manifesting in myocarditis linked with Covid-19. Methods: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible case reports and case series were included from around the world without any language restrictions. For this review, inclusion criteria were laboratory-confirmed SARS-CoV-2 infection cases reporting a diagnosis of acute myocarditis. Results: Data from 41 studies describing myocarditis in 42 Covid-19 patients was obtained. The median age of these patients was 43.4 years, with 71.4% of them being male. Fever was the most prevalent presenting symptoms seen in 57% of patients. Hypertension was the most pervasive comorbidity accompanying these patients. Cardiac biomarkers troponin and Brain natriuretic peptide (BNP) were raised in almost 90% and 87% of patients, respectively. Electrocardiogram findings were Non-specific and included ST-segment and T-wave changes. The most prevalent histopathological feature appreciated was diffuse lymphocytic inflammatory infiltrates. Antivirals and corticosteroids were the most frequently used medications. About 38% of patients also needed vasopressor assistance. Out of 42 patients, 67% recovered, and eight died. Conclusion: Due to the risk of a sudden worsening of patients conditions and myocarditis association with considerable mortality and morbidity, a knowledge of this cardiac complication of Covid-19 disease is crucial for healthcare professionals.

Incidence of metastasis in circumflex iliac nodes in patients with cervical cancer: a systematic review

2021 ◽  
pp. ijgc-2021-003005
Author(s):  
David Viveros-Carreño ◽  
Juliana Rodriguez ◽  
Rene Pareja
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Lymph Node ◽  
English Language ◽  
Early Stage ◽  
Case Reports ◽  
Pelvic Lymphadenectomy ◽  
Positive Lymph Node ◽  
Cochrane Central Register ◽  
Early Stage Disease

ObjectiveThe circumflex iliac nodes distal to the external iliac nodes are frequently removed when bilateral pelvic lymphadenectomy is performed in patients with cervical cancer. The objective of this systematic review was to assess the incidence of metastasis in the circumflex iliac nodes in patients with cervical cancer.MethodsPubMed/Medline, ClinicalTrials, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Ovid databases were searched from inception to May 2021. We included articles published in English language reporting all types of studies, except for case reports and commentaries. Abstracts and unpublished studies were excluded. The inclusion criteria were diagnosis of cervical cancer, FIGO 2009 stages IA–IIB, squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma, and primary surgery including pelvic lymph node dissection.ResultsA total of 3037 articles were identified. Overall, 1165 eligible patients from four studies were included in the analysis. A total of 696 (59.7%) patients had early-stage disease (FIGO 2009 stages IA, IB1, IIA1). The median number of extracted circumflex iliac nodes, which was reported in two studies, was one (range not reported) and three (range 1–13). The positive lymph node rate for the entire population and circumflex iliac node involvement were 26.9% and 3.1%, respectively. Isolated metastases were reported for 904 patients (three studies) and in one patient nodal spread was detected (0.11%).ConclusionThe rate of isolated metastases in circumflex iliac nodes is small and excision of these lymph nodes as part of routine lymphadenectomy should be avoided.

scholarly journals P8-7 Overall survival outcome of an early stage non-small cell lung cancer in stereotactic radiosurgery: Systematic review

2021 ◽  
Vol 32 ◽  
pp. S334
Author(s):  
Axel Sebastian Siregar ◽  
Natasha Karlina Law ◽  
Indra Kusuma ◽  
Felix Wijovi ◽  
Andree Kurniawan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Stereotactic Radiosurgery ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Survival Outcome ◽  
Small Cell ◽  
Small Cell Lung

scholarly journals Lactation Ketoacidosis: A Systematic Review of Case Reports

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 299
Author(s):  
Abdullah M. Al Alawi ◽  
Asma Al Flaiti ◽  
Henrik Falhammar
Keyword(s):  
Systematic Review ◽  
Metabolic Acidosis ◽  
Case Reports ◽  
Case Series ◽  
Anion Gap ◽  
Precipitating Factors ◽  
Presenting Symptoms ◽  
Child Weight ◽  
Balanced Diet ◽  
Relevant Case

Background and Objective: Lactation ketoacidosis is a rare cause of high anion gap metabolic acidosis affecting breastfeeding mothers. We aim to review and analyze all cases of lactation ketoacidosis reported. Materials and Methods: A systematic search of PubMed/MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL), identifying relevant case reports published from 1 January 1970 to 31 December 2019. We extracted the following data: the first author, country, year of publication, age of the mother, age of the child, weight/body mass index (BMI) of the mother, precipitating factors, presenting symptoms, biochemical results, treatment, breastfeeding, and time from presentation to the resolution of ketoacidosis. Results: Sixteen case reports and 1 case series reporting 18 cases of lactation ketoacidosis were found. Presenting symptoms were nausea (72%, 13/18), vomiting (67%, 12/18), malaise (56%, 10/18), abdominal pain (44%, 8/18), dyspnea (33%, 6/18), headache (22%, 4/18), and palpitation (11%, 2/18). Dieting and physical exercise to lose weight were reported in 76% (14/18). The treatments included IV dextrose, sodium bicarbonate, insulin, rehydration, monitoring and replacement of electrolytes, and resumption of a balanced diet. The prognoses were good, with no mortalities. Conclusions: lactation ketoacidosis should be suspected in unwell breastfeeding women with high anion gap metabolic acidosis, after excluding other causes.

scholarly journals Mortality risk factors of COVID-19 infection in kidney transplantation recipients: a systematic review and meta-analysis of cohorts and clinical registries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Suwasin Udomkarnjananun ◽  
Stephen J. Kerr ◽  
Natavudh Townamchai ◽  
Paweena Susantitaphong ◽  
Wasee Tulvatana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Kidney Transplantation ◽  
Mortality Risk ◽  
Case Reports ◽  
Meta Analysis ◽  
Factors Associated ◽  
Presenting Symptoms ◽  
Risk Of Death ◽  
Published Evidence

AbstractKidney transplantation recipients (KTR) with coronavirus disease 2019 (COVID-19) are at higher risk of death than general population. However, mortality risk factors in KTR are still not clearly identified. Our objective was to systematically analyze published evidence for risk factors associated with mortality in COVID-19 KTR. Electronic databases were searched for eligible studies on 1 August 2021. All prospective and retrospective studies of COVID-19 in KTR were considered eligible without language restriction. Since data in case reports and series could potentially be subsets of larger studies, only studies with ≥ 50 patients were included. Random-effects model meta-analysis was used to calculate weighted mean difference (WMD) and pooled odds ratio (OR) of factors associated with mortality. From a total 1,137 articles retrieved, 13 were included in the systematic review and meta-analysis comprising 4,440 KTR. Compared with survivors, non-survivors were significantly older (WMD 10.5 years, 95% CI 9.3–11.8). KTR of deceased donor were at higher risk of death (OR 1.73, 95% CI 1.10–2.74). Comorbidities including diabetes mellitus, cardiovascular disease, and active cancer significantly increased mortality risk. KTR with dyspnea (OR 5.68, 95% CI 2.11–15.33) and pneumonia (OR 10.64, 95% CI 3.37–33.55) at presentation were at higher mortality risk, while diarrhea decreased the risk (OR 0.61, 95% CI 0.47–0.78). Acute kidney injury was associated with mortality (OR 3.24, 95% CI 1.36–7.70). Inflammatory markers were significantly higher in the non-survivors, including C-reactive protein, procalcitonin, and interleukine-6. A number of COVID-19 mortality risk factors were identified from KTR patient characteristics, presenting symptoms, and laboratory investigations. KTR with these risk factors should receive more intensive monitoring and early therapeutic interventions to optimize health outcomes.

scholarly journals Clinical Manifestations and Characterization of COVID-19 in Liver Transplant Recipients: A Systematic Review of Case Reports and Case Series

2021 ◽  
Vol 31 (2) ◽  
Author(s):  
Pirouz Samidoust ◽  
Hamed Nikoupour ◽  
Hossein Hemmati ◽  
Aryan Samidoust
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Case Reports ◽  
Laboratory Finding ◽  
Clinical Manifestations ◽  
Case Series ◽  
Presenting Symptoms ◽  
Severity Of The Disease ◽  
High Level

BACKGROUND፡ This systematic review is conducted to explore available information on clinical presentations, laboratory finding and outcomes of SARS-COV-2 in liver transplant patients.METHODS: We searched four databases for relevant terms related to COVID-19 and liver transplantation and collected both case reports and case series on liver transplantation published up to the end of September 2020.RESULTS: After initial screening of irrelevant articles, 25 studies were included and analyzed in this review. Among the 59 patients included,78.3% were over 50 years old, and 71.6% were males. The majority of patients (93.3%) were hospitalized. The most common presenting symptoms were fever (72.9%) followed by dyspnea and cough (54.2%). The majority of patients revealed a high level of CRP (64.3%). Moreover, high level ALT, AST and ALP were reported in 64.3, 37.5, 30.5 and 22.2% of patients. A total, 9(15.3%), of cases died as a result of complications of COVID-19. Chest radiographs were reported in 72.9%(43/59) of cases that 94% demonstrated radiologic evidence of abnormality.CONCLUSION: The results demonstrated that the most prevalent symptoms and signs were fever, dyspnea and cough. Moreover, most patients were males and hospitalized. The rate of mortality and high level of CRP, ALT/AST and ALP is similar within the non-immune suppressed and general population. However, early detection of high level of serum CRP, ALT/AST and ALP combined with a clinical COVID-19 symptom and finding of CT scan may be used as an index for the presence and severity of the disease.

Sinonasal Osteosarcoma: Report of 14 New Cases and Systematic Review of the Literature

2020 ◽  
Author(s):  
Christopher M. Low ◽  
Nelson R. Gruszczynski ◽  
Eric J. Moore ◽  
Daniel L. Price ◽  
Jeffrey R. Janus ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Survival Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Survival Rates ◽  
Disease Specific Survival ◽  
Review Of The Literature ◽  
Presenting Symptoms ◽  
Disease Specific

Abstract Objective The objective of this study is to describe the clinical presentation, tumor characteristics, natural history, and treatment patterns of sinonasal osteosarcoma. Methods Fourteen patients who had been treated for osteosarcoma of the nasal cavity and paranasal sinuses at a tertiary care center were reviewed. In addition, a systematic review of the literature for osteosarcoma of the sinonasal cavity was performed. Results In a systematic review, including 14 patients from the authors' institution, 53 total studies including 88 patients were assessed. Median follow-up was 18 months (interquartile range: 8–39 months). The most common presenting symptoms were facial mass or swelling (34%), and nasal obstruction (30%). The most common paranasal sinus involved by tumor was the maxillary sinus (64%), followed by the ethmoid sinuses (52%). The orbit (33%), dura (13%) and infratemporal fossa (10%) were the most common sites of local invasion. The majority of patients underwent surgery followed by adjuvant therapy (52.4%). Increasing age was associated with decreased overall survival rate (unit risk ratio [95% confidence interval (CI)] = 1.02 [1.003–1.043]; p = 0.0216) and T4 disease was associated with decreased disease-specific survival rate (hazard ratio [HR] = 2.87; p = 0.0495). The 2- and 5-year overall survival rates were 68 and 40%, respectively, while 2- and 5-year disease-specific survival rates were 71% and 44%, respectively. Conclusions Sinonasal osteosarcomas are uncommon tumors and can pose a significant therapeutic challenge. Increasing age and T4 disease are associated with worse prognosis. This disease usually warrants consultation by a multidisciplinary team and consideration of multimodality therapy.

Incidence and implications of oligometastatic breast cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11512-e11512 ◽  
Author(s):  
Supriya K. Jain ◽  
Paige L. Dorn ◽  
Steven J. Chmura ◽  
Ralph R. Weichselbaum ◽  
Yasmin Hasan
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Early Stage ◽  
Significant Proportion ◽  
Local Therapy ◽  
Breast Cancer Patients ◽  
Stereotactic Radiation ◽  
Presenting Symptoms ◽  
Distant Failure

e11512 Background: There is increasing evidence that prolonged disease control is possible in patients with a limited number of metastatic sites compared to those with more diffuse disease, especially when aggressive local therapy (surgery and/or stereotactic radiation) is administered. The objective of this study is to describe the frequency of oligometastatic breast cancer in patients who develop distant disease and to characterize their disease course. Methods: A retrospective review was performed of a tri-institutional database of Stage I-III breast cancer patients treated from 1978 to 2005. Patients were categorized as "oligometastatic" (OM) if ≤ 5 sites of disease were identified at time of first failure or “polymetastatic” (PM) if failure occurred at > 5 sites. Patients were followed for ≥ 3 y after first metastasis, until death, or until development of > 5 sites of metastatic disease. T and N stage, hormone receptor status, presenting symptoms of metastasis, number and site of metastases, actuarial overall survival (OS), and overall survival after first failure (OSAF) were examined. Kaplan-Meier, chi-square, and log-rank tests were used for statistical analysis. Results: Of 2,249 patients reviewed, 114 (5.1%) failed at distant sites and met inclusion criteria. The OM phenotype was observed in 21.9% (25/114). Of patients presenting with symptoms of metastasis, 18.3% were OM, whereas patients with metastases identified incidentally or by screening were OM in 42.1% of cases (p = 0.02). Median OSAF was significantly longer in OM patients (44.7 mos) than PM patients (18.1 mos) with 5 y OS of 48.5% and 10.7% respectively (p < 0.001). Outcome of OM patients compared favorably to that of patients with bone-only metastases in whom the median OSAF was 25 mos and 5 y OS was 12.5%. Baseline features of OM and PM patients did not differ according to initial tumor size (p = 0.94), nodal stage (p = 0.5), or ER+ (p = 0.28). Conclusions: A significant proportion of early stage breast cancer patients with distant failure will have OM disease, and this subset is expected to have prolonged overall survival. The relatively favorable prognosis of patients with OM disease warrants consideration of aggressive local therapy and may have implications in the design of future clinical trials.

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